The Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain

Abstract

Introduction Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP. Methods The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7–14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach’s α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups. Results The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were –5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population. Conclusions The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.

Knowledge, attitude, and perception of low back pain and activities that may prevent it among adolescents in Nigeria

“…Negative attitudes and beliefs on pain have been confirmed to be a barrier to achieving the desired treatment outcomes 29 . Thus, a positive attitude and perceptions are essential in preventing LBP 30 .…”

Primary Investigation of Low Back Pain among Saudi Arabians: A Cross-Sectional Study

“…Furthermore, over 60% believe (or are uncertain) that back trouble means periods of pain for the rest of their life. In recent research, the BBQ was used in various countries, such as Canada, Brazil, the Caribbean, Turkey, Nigeria, France, and Australia, to investigate people's beliefs about back pain and pain management [7,8,[19][20][21][22][23]. Respondents in all the previous studies agreed, on average, that back pain has unhelpful consequences, which resulted in BBQ ratings in the range 23.2-28.…”

Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial

“…[ 75 ]. Back pain consequences belief were assessed using the reliable and valid Hausa version of the back beliefs questionnaire (BBQ) [ 76 ]. It is scored 9–45, with nine items (1, 2, 3, 6, 8, 10, 12, 13, and 14) after reversing.…”

“…It is scored 9–45, with nine items (1, 2, 3, 6, 8, 10, 12, 13, and 14) after reversing. Higher scores indicate less pessimistic beliefs regarding the consequences of back pain [ 76 ]. Pain medication use was assessed by recording the number of pain tablets ingested in the past 4 weeks (prior to commencement of the study) at baseline and 8-week follow-up.…”